THREDBO 2019 45th ANNUAL SCIENTIFIC MEETING OF THE SOCIETY OF

THREDBO 2019 45th ANNUAL SCIENTIFIC MEETING OF THE SOCIETY OF NEUROMUSCULAR SCIENCE INC From its inception, S.O.N.S. has encouraged medical professionals from a wide spectrum of specialities and general practice, to gather for professional education and enrichment in a relaxed atmosphere in the snow. Since its foundation in 1974, the main event is the annual conference held each August at the Thredbo conference centre. It is a unique opportunity for doctors and allied health from different backgrounds but with common interests to learn and develop their skills and knowledge. Of course, it is also a rare opportunity to network with other doctors across professional and geographic boundaries to foster new professional and interpersonal relationships in a convivial environment. August 5th - 8th 2019 Townsend Room Thredbo Alpine Conference Centre Thredbo Village NSW

Annual Message from the Chairman. 2019 Committee . EXECTUTIVE Chairman: Dr Allan Forrest [email protected] Vice Chairman: Prof Leslie White [email protected]. au MEMBERS Dr Cameron Altmann drcameronaltmann@bigpond .com Dr David Bollinger davidbollingersydney@yaho o.com.au Dr Christine Barrows [email protected]. au Dr James Deves [email protected] .au Dr Bradley Fawkes [email protected] Dr Brenton Kermode [email protected] Welcome to the 45th Annual General Meeting of The Society of Neuromuscular Sciences here at Thredbo. We have a long relationship with The Thredbo Alpine Hotel and look forward to it continuing. My sincere thanks to the SONS Committee for their help and advice in running the organization, and to Kym James for her great job actually running the organization. I would also like to thank Christine Barrow for taking on the Coordinators role for this meeting. There is a very interesting programme. scheduled so please try to come to as many of the talks as you can. We have a special presentation from the Thredbo Ski Patrol on Wednesday evening. The SONS meeting in Niseko with the extension at Kiroro continues to be a great success. In 2020 we are running a little close to the Japanese New Year Holidays so the meeting will be delayed in subsequent years to commence immediately after the second weekend in January instead of the beginning of the second week. This years meeting was well attended and there were very interesting talks in Niseko. Marcus Chin from Perth won the prize donated once again by Jeff Bowman from WealthTree Solutions. His presentation on Endoscopic Management of Early Gastric Cancer was literally cutting edge stuff. There was a special camaraderie built up among the smaller group that went on to Kiroro. One such moment was during the presentation of Saretta Lee on Mental Health in the medical profession. She stimulated a conversation among the delegates which was sympathetic, empathetic and helpful all at once. We decided that most of us need more help when it comes to dealing with the rigors of life around being a caring doctor.

Monday - August 5th SONS Tuesday - August 6th Annual General Meeting 4.00pm – 6.00pm Convenor – Dr Christine Barrow Convenor – Dr Christine Barrow 3.30pm - Registration 4.00pm – 4.40pm - Dr Bradley Fawkes 3.45pm – 4.00 pm – Welcome Topic: What Anaesthetists want. 4.00pm – 4.30pm - Prof Les White Topic: The new world of precision medicine for children with cancer 4.40pm – 5.20pm - Dr James Deves 4.30pm – 5.00pm – Adam Carr Topic: Arboviruses and other infections Topic: The Science of Coffee 5.00pm 5.45pm Annual General Meeting Chairman – Dr Allan Forrest 6.00pm – Ice Breaker Cocktail Party – drinks and finger food. (Townsend Room) 5.20pm – 6.00pm - Dr Bryan Fain Topic: Imaging in patients with Lung disease Lucky door prize

Wednesday - August 7th Thursday - August 8th Convenor – Dr Christine Barrow Convenor – Dr Christine Barrow 4.00pm – 6.00pm 4.00pm – 6.00pm 4.00pm – 4.40pm - Prof Les Schrieber 4.00pm – 4.40pm - Dr Joseph Konya Topic: Immunotherapy for Melanoma – Immune mediated adverse effects. Topic: Eyelid Dermatoses 4.40pm – 5.20pm - Dr David Jones 4.40pm – 5.20pm - Dr Peter McLaran Topic: Military Anaesthesia 5.20pm – 6.00pm - Steve Phillips, Thredbo Ski Patrol Topic: Fill the gap-dental implants, where are we now? 5.20pm – 6.00pm - Dr Allan Forrest Topic: General Washington and all that” Topic: Trauma Management Lucky door prize Lucky door prize

Social Programme Monday 7th August 6.00pm Ice Breaker following the AGM in the Townsend Room * Drinks and Finger food provided Wednesday 9th August 7.00pm Dinner in the Cascades Restaurant. * Sit down 3 course dinner with beer and wine.

ABSTRACTS Prof Les White Bio Les White was the inaugural NSW Chief Paediatrician from September 2010 to June 2016. He was previously Executive Director of Sydney Children's Hospital (1995-2010), following a clinical and academic career, with emphasis on childhood cancer. Other positions have included President of Children’s Hospitals Australasia (1999-2004) and the John Beveridge Professor of Paediatrics (20052010). He has over 120 publications and many more abstracts, awards, grants and invited presentations in his CV. He serves on 8 not-forprofit boards relating to children’s health or medical research. He was awarded a Doctorate of Science for research contributions related to childhood cancer and holds a Master of Health Administration. In 2007 he received an Order of Australia award for service to medicine, medical administration and the community in the field of paediatrics. The new world of precision medicine for children with cancer. The management of childhood cancer has served as an exemplar of research based improvement since the 1960’s. In that half a century the cure rates have moved from close to nil to about 80%. In recent times that progress has plateaued and the treatment morbidity has remained a major challenge. The advent of precision or personalised medicine has created a new paradigm for both the study and treatment of childhood cancer. A current Australian national initiative is once again leading the international oncology community in seeking to translate the new science to safe and appropriate practice”.

ABSTRACTS Adam Carr Bio Adam Carr has a PhD in Chemical Engineering, and currently manages Seven Miles Coffee Science and Education Centre. His expertise lies in coffee extraction, pharmaceutical engineering and reaction engineering kinetics. He finds it hard to describe precisely what he does at Seven Miles, but most days are spent analyzing coffee chemistry and innovating new methods of extraction. His recent publications have moved from the academic sphere to the public sphere, having written articles for the Sydney Morning Herald, The Australian, through the podcast Coffee, Science, Guru, and interviews on public radio. Adam loves talking all things coffee. The Science of Coffee and the effects on health. “Who doesn’t love a good cup of coffee? Often described as the future’s last legal drug, there has been a lot of hype surrounding the health benefits or carcinogenic risk of coffee when consumed in even moderate quantities. Recently, much of the research has been conducted on genetic tolerance to some of the active therapeutic compounds in coffee, identifying the best time to consume coffee, as well as potential predisposition towards cancer. In this talk, a brief background to the processing and production of coffee will be described, along with a chemical description of coffee and some of the recent health research linked to the chemistry. Ultimately, we hope to convey a wholistic appreciation for coffee as one of the worlds most consumed beverages.”

ABSTRACTS Dr Bradley Fawkes Bio MB BS FANZCA PG Dip Echo Currently VMO Anaesthetist at North Shore Private Hospital and The Mater Hospital , Sydney , Australia. Trained at Royal North Shore Hospital (Sydney), St.Georges Hospital ( London), and Duke University Medical Centre (NC, USA) What Anaesthetists Intraoperative mortality from anaesthetic causes in the Western world is now so low as to be essentially immeasurable. In contrast, postoperative mortality remains common, with about 2% of United States surgical inpatients dying within a month— mostly of cardiovascular causes. Longer-term mortality is even more common, with about 5% of surgical patients dying within a year; among patients more than 65 yr of age (about a third of U.S. surgical patients), a staggering 1 in 10 patients are dead within a year of inpatient surgery. The leading cause of long-term mortality is cancer. Hence anaesthetists have developed an interest in attempting to modify perioperative poor outcomes related to cardiac death, cancer recurrence, opioid addiction and other causes. This presentation will review current concepts and outline my personal approach to this developing endeavour.

ABSTRACTS Dr Bradley Fawkes Bio MB BS FANZCA PG Dip Echo Currently VMO Anaesthetist at North Shore Private Hospital and The Mater Hospital , Sydney , Australia. Trained at Royal North Shore Hospital (Sydney), St.Georges Hospital ( London), and Duke University Medical Centre (NC, USA) What Anaesthetists Intraoperative mortality from anaesthetic causes in the Western world is now so low as to be essentially immeasurable. In contrast, postoperative mortality remains common, with about 2% of United States surgical inpatients dying within a month— mostly of cardiovascular causes. Longer-term mortality is even more common, with about 5% of surgical patients dying within a year; among patients more than 65 yr of age (about a third of U.S. surgical patients), a staggering 1 in 10 patients are dead within a year of inpatient surgery. The leading cause of long-term mortality is cancer. Hence anaesthetists have developed an interest in attempting to modify perioperative poor outcomes related to cardiac death, cancer recurrence, opioid addiction and other causes. This presentation will review current concepts and outline my personal approach to this developing endeavour.

ABSTRACTS Dr James Deves Bio Jim is an ENT surgeon who has retired from private practice in Gosford, but continues to provide waiting list reduction surgery for overworked ENT colleagues at several hospitals. This has given him the opportunity to spend time in communities from Tasmania, to North Queensland, to Central Australia. He saw unfamiliar tropical conditions from leprosy to the effects of the box jellyfish as a surgical registrar in Townsville in 1974, and from TB to “Madura foot” as a RAAF reserve surgeon for the multinational peacekeeping force in Bougainville in 1999 and 2000. He has maintained an interest in non-ENT conditions, and recently looked into unusual Australian infections many of which are arthropod borne. Arboviruses and other infections Australia has many arthropod borne endemic infections, and has arthropods which are potential carriers of currently exotic infections. Tropical Australia is the main site of many of these infections, and climate change facilitates the southward extension of their range. Clinical features, carriers of and reservoirs of these infections will be discussed.

ABSTRACTS Dr Bryan Fain Bio INTERVENTIONAL AND DIAGNOSTIC RADIOLOGIST MBBCH, FFRAD.D.SA FRANZCER Pleural and abdominal cavity drainage . Breast and thyroid biopsy Specializing in Musculoskeletal Radiology Hand, Shoulder , Hip and Foot ultrasound guided injections. Cervical and lumbar spine pain management. Currently on staff I-MED RADIOLOGY POW Private Hospital Personal interests Golf , Art, Tennis and Skiing Imaging in patients with lung disease An Expose of a clinical approach to Lung disease, as seen from the Radiologist Perspective Discussion of an approach to diagnosis of recognisable Lung disease from plain x Ray signs and further Imaging particularly CT scan. The innocuous Chest X-Ray- what am I missing, what can I see? Key Diagnostic features and Differential Diagnoses pertaining to given History with patient and doctor input using Imaging techniques - a standard Radiologic approach. What should you be looking for in a chest x Ray and CT scan pertaining to Infection, lung cancer and Industrial Lung disease and Interstitial Lung Disease?

ABSTRACTS Professor Leslie Schrieber Bio Les Schrieber is an Honorary Associate Professor of Medicine in the Sydney Medical School at Royal North Shore Hospital. He is a consultant rheumatologist with particular expertise in inflammatory rheumatic and autoimmune diseases. These include rheumatoid arthritis, lupus and scleroderma. He has a major interest in the education of medical students and physician trainees. Immunotherapy for Melanoma- immune mediated – adverse effects Traditionally malignant melanoma was considered to be a rare fatal disease. Neither of these statements is now correct. In Australia melanoma affects 4% of the population. Recent advances with early detection and immunotherapy have dramatically improved the prognosis. There are naturally occurring cell surface molecules on lymphocytes know as checkpoint inhibitors (CPIs) which prevent the immune system from destroying tumour cells. Monoclonal antibodies which specifically block these CPIs have been developed and applied to the treatment of melanoma. They have produced dramatic effects, enabling host lymphocytes to kill melanoma cells and improve patient survival. However, up to 40% of patients develop immune adverse effects from this treatment ranging from thyroiditis, colitis, skin rashes to arthritis. Mostly mild and controlled with anti-inflammatory drugs or corticosteroids they are occasionally life threatening. With the application of this treatment to other malignancies including non- small cell lung cancer and urogenital tumours it is inevitable that we will see more patients with these reactions. It behoves oncologists and other physicians to be aware of this new entity.

ABSTRACTS Dr Peter McLaran Bio Military Anaesthesia Peter grew up on the north coast of NSW and graduated from medical school at UNSW in Sydney. Following internship and several resident terms he spent 18 months as a medical officer in PNG. His anaesthetic training included Plymouth in the U.K., Brisbane and Perth. After spending a fair few years in practice in Lismore, in northern NSW, he moved to the Gold Coast in 2005. He has four children, three of whom have followed him into medicine with the fourth, sensibly, undertaking business studies. He lives in Southport with his wife, Helen and several King Charles Cavalier spaniels. He spent 15 years in the Army Reserve. His interests include medical education, writing and occasional exercise. I am a specialist anaesthetist in private practice on the Gold Coast. During my time in the Army Reserve I deployed to Timor Leste several times and once to Afghanistan. Wars have always been test beds for trauma management. My presentation is both from personal experience and a distillation of current practice, outlining points that impinge on the management of civilian trauma in Australia. Peter McLaren MBBS(NSW) FANZCA

ABSTRACTS Dr Joseph Konya Bio 1997 – present: Full time practice in Dermatology at Epping – general dermatology and dermatological surgery. 1998 – present: Skin Hospital - Westmead – I run a specialised Contact Dermatitis Clinic and offer a full patch testing facility for investigating problems related to allergic contact dermatitis and occupational dermatitis. 2001 – present Visiting Dermatologist at Sydney Adventist Hospital. 2016 – present Associate Editor of Australasian Journal of Dermatology Director on board of St Elizabeth Nursing Home Eyelid Dermatoses There a large number of dermatoses that may affect the eyelid. Most dermatoses affecting the skin can affect the eyelid in some way, either as part of the more widespread eruption, or it may be localised solely to the eyelid. These are covered with regard to the anatomy and function of the eyelid.

ABSTRACTS Dr David Jones Bio Dr Jones graduated from Sydney University in 1979 with a Bachelor of Dental Surgery. He is an affiliate of the International College of Prosthodontics, was awarded membership of the Pierre Fauchard Academy for continued clinical excellence. He is also a long serving member of Australian Prosthodontic Society, the Australian Society of Periodontology, and the Australian Osseointegration Society. Dr Jones has 38 years experience with Osseintegrated implants and the last 34 years using Nobel Biocare Implants and has taught DTX Studio (Nobel Clinician and guided surgery) since its inception. David has run a private practice since 1983 in the North Sydney area with special interest in implants and comprehensive dental care& dental practice management. “Fill the gap-dental implants, where are we now” Not provided

ABSTRACTS Dr Allan Forrest Bio Dr Allan Forrest MB;BS FRACS is a general Otolaryngologist in Private Practice in Dee Why . Visits Ryde Public Hospital, North Shore Private and Delmar Private Hos- pitals. I spent one year in Sannohe, Aomori ken as a Rotary Exchange Student in 1975. I have continued my interest in Japanese language, culture and history ever since. My eldest son Matthew and his family (including Jack our only grandson aged 2)live in Kobe near Osaka so Marjolein and I come over to visit as often as we can. I am very happy to be serving the SONS group as Chairman. The skiing in Japan is of course great, but the camaraderie and new friendships gained are a lifelong treasure. My par- ticular thanks to those who sent good wishes to me last year when I could not come to Niseko through illness. Hopefully no more of that and I look forward to re-presenting a talk I gave first about 8 years ago on the Japanese Samurai. “General Washington and all that” George Washington was the first President of the United States of America. He was loved and regarded as the father of the nation. Unfortunately he died miserably from an acute illness of ENT origins, in 1799. The exact cause of his demise are still debated but I will try to surf the net and debunk any myths about his final hours . I will show the differential diagnosis and how these illnesses are very successfully treated nowdays.

MINUTES OF THE FOURTY SECOND ANNUAL GENERAL MEETING of THE SOCIETY OF NEUROMUSCULAR SCIENCES INC THE THREDBO ALPINE HOTEL CONFERENCE CENTRE AUGUST 6th 2018 The Chairman, Dr Allan Forrest, opened the meeting at 5.08pm and welcomed the Delegates to the Conference. Attendees: Dr Allan Forrest, Prof Les White. Dr Sue Acton. Dr Adrian Sue, Dr Brenton Kermode, Dr Bradley Fawkes, Dr David Bollinger, Dr Andrew Fulton, Prof Bill Gibson, Dr Sean Williams, Dr Jim Deves, Dr Julian Scullin, Dr John Barker-Whittle, Dr Tim Lyon, Dr Christine Barrow, Dr Doug Barrow, Dr David Lewis, Dr Bruce Fasher, Dr Rebecca Glover, Dr Monique Damasco, Dr Alister Jones, Dr David Jones, Sr Anne Kermode, Ms Kym James Apologies: Dr Cameron Altmann, Dr Adrian van der Rijt. Minutes of the previous meeting Dr Allan Forrest advised that the minutes had been distributed for reading and moved that they be accepted. Moved: Dr Christine Barrow Seconded: Prof Les White Business arising from previous meeting Dr Allan Forrest advised that it was not possible for the Society to have a bank account in Japan.

Chairman’s Report I wish to thank many SONS members who have continued to support me this year. I was diagnosed with Prostate Cancer just before the end of 2017 and underwent Radical Robotic Surgery 3 days before Christmas. For that reason I could not attend Niseko/Kiroro 2018, so I will include the following report from Niseko Co-convenor and SONS committee member Dr Cameron Altman, who grandly stepped up in my stead to run those conferences, with Kym James. I am very grateful, thanks Cameron and Kym. Cameron’s report is available on the website. I am back working full time again. The SONS Committee including several ex officio members met to discuss many aspects of the Society in May this year. This followed a very successful meeting in May 2017 at North Shore Private Hospital. The main item of discussion was the future of Thredbo as a viable meeting for SONS and the time and place for its AGM. People are very reluctant to end this meeting. Probably because of its long history and SONS deep relationship with Thredbo. . BUT it is going to have to be more strongly supported to viably continue. Committee members were close to closing down Thredbo from next year but the meeting received a lifeline from Christine Barrow who has agreed to organise the programme for next year. I will be taking a break from convening the Scientific component of the Thredbo meeting. As you can see from Cameron Altmann’s report the Niseko meeting continues to thrive with the add on Kiroro conference being enjoyed by most members who attended. It will be held again in January 2019 and Marjolein and I hope to see you all there. It’s a lot of fun, and the scientific programme has always proven to be excellent. I will ask committee members as well as general SONS membership about possible alternatives to Thredbo, such as a weekend scientific meeting in Australia to be held in the 2 nd half of the year so the AGM can be legitimately held within 3 months of the end of the financial year. If the Thredbo meeting receives a sudden boost in interest (and doesn’t lose money) then I presume it will continue. The May 2018 Committee meeting minutes make for interesting reading and I commend them to all

Treasurer’s Report As at June 30th 2018 Financial Members: 96 New Members: 41 Un-Financial: 82 Formally Resigned: 1 Kym James advised that to June 30 there had been no significant change to Expenses, however, due to a large drop in registrations number in January 2018 for Niskeo, Income was down. The annual profit for 2017-2018 period dropped to 17,980 from 43,599 in 2017 as a result. As at June 30 2016 total assets were 249,818 Account balance details June 30 2018 NAB Cheque 118,890 NAB Holding Account 11,634 Total Interest earned 1,163 Note: Our Term deposit matures on September 23 2018 Prepared by Kym James Secretary/Treasurer for the Society of Neuromuscular Sciences Incorporated August 6th 2018 Kym asked that the Report be accepted. Moved: Dr Allan Forrest Seconded by Dr John Barker-Whittle Page 3 of 7

Business arising from the Treasurers Report. Dr Allan Forrest requested that the Holding Account be closed and funds transferred to the Cheque Account and 50,000 be transferred to the Term Deposit. Moved: Dr Allan Forrest Accepted: Dr Breton Kermode Dr Andrew Fulton asked why there were so many unfinancial members and Kym explained that this number was not unusual as people join to make use of SONS and then go with only some returning in later years. Others choose not to renew for personal reasons. Page 4 of 7

Election of Office bearers Dr John Barker-Whittle declared that all Committee positions were vacated. A call from the floor and the following Nominations were received and accepted by unanimous vote: Dr Allan Forrest (Chairman) Prof Les White (Vice Chairman) Dr Cameron Altmann (in Absentia) Dr Christine Barrow Dr Jim Deves Dr Brenton Kermode Dr Bradley Fawkes Dr David Bollinger Public Officer Kym James Moved: Dr Alan Forrest Seconded: Dr Brenton Kermode Page 5 of 7

General Business Dr Allan Forrest noted that Dr John Barker-Whittle has resigned from the Committee, thanking him for his past efforts as previous Chair and current Bank Signatory. He advised that Dr David Bollinger will replace him as the third signatory. Those being Ms Kym James (Treasurer), Dr Allan Forrest (Chairman) and Dr David Bollinger. General discussion regarding donations. No decisions made. Dr Allan Forrest thanked Dr Christine Barrow for offering to Convene the Scientific component of Thredbo for next year and possibly moving forward. Although consideration must be given as to the viability of continuing Thredbo after looking at the financials following the Conference. Dr Allan Forrest said that discontinuing Thredbo would create problems with holding our AGM which must be held within three months following the end of the Financial Year. Dr Bradley Fawkes asked if that was due to SONS Constitution and Kym James advised that it was Association Law. It was acknowledged that, should the conference format at Thredbo prove not sustainable, a number of alternatives for the AGM can be given consideration.

Fee and Registrations. Dr Allan Forrest asked for opinions on the current fee and registration fees. General discussion and agreed they remain unchanged. Next AGM to be held 5pm August 5th 2019 at the SONS Thredbo Conference Meeting adjourned 5.40 pm Page 7 of 7

The Society of Neuromuscular Sciences Ltd Contact Details Secretary/Treasurer/Public Officer Kym James 0432 797 366 Kym James [email protected] www.sons.net.au Postal Address 81 Braeside Drive UKI NSW 2484 FUTURE CONFERENCE DATES 2020 Niseko/Kiroro JAPAN January 6th – 11th Kiroro 12th – 14th 2020 Thredbo AGM August 5th – 8th